Welcome to the Nexus of Ethics, Psychology, Morality, Philosophy and Health Care

Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy

Monday, September 27, 2021

An African Theory of Moral Status: A Relational Alternative to Individualism and Holism.

Metz, T. (2012).
Ethic Theory Moral Prac 15, 387–402. 
https://doi.org/10.1007/s10677-011-9302-y

Abstract

The dominant conceptions of moral status in the English-speaking literature are either holist or individualist, neither of which accounts well for widespread judgments that: animals and humans both have moral status that is of the same kind but different in degree; even a severely mentally incapacitated human being has a greater moral status than an animal with identical internal properties; and a newborn infant has a greater moral status than a mid-to-late stage foetus. Holists accord no moral status to any of these beings, assigning it only to groups to which they belong, while individualists such as welfarists grant an equal moral status to humans and many animals, and Kantians accord no moral status either to animals or severely mentally incapacitated humans. I argue that an underexplored, modal-relational perspective does a better job of accounting for degrees of moral status. According to modal-relationalism, something has moral status insofar as it capable of having a certain causal or intensional connection with another being. I articulate a novel instance of modal-relationalism grounded in salient sub-Saharan moral views, roughly according to which the greater a being's capacity to be part of a communal relationship with us, the greater its moral status. I then demonstrate that this new, African-based theory entails and plausibly explains the above judgments, among others, in a unified way.

From the end of the article:

Those deeply committed to holism and individualism, or even a combination of them, may well not be convinced by this discussion. Diehard holists will reject the idea that anything other than a group can ground moral status, while pure individualists will reject the recurrent suggestion that two beings that are internally identical (foetus v neonate, severely mentally incapacitated human v animal) could differ in their moral status. However, my aim has not been to convince anyone to change her mind, or even to provide a complete justification for doing so. My goals have instead been the more limited ones of articulating a new, modal-relational account of moral status grounded in sub-Saharan moral philosophy, demonstrating that it avoids the severe parochialism facing existing relational accounts, and showing that it accounts better than standard Western theories for a variety of widely shared intuitions about what has moral status and to what degree. Many of these intuitions are captured by neither holism nor individualism and have lacked a firm philosophical foundation up to now. Of importance here is the African theory’s promise to underwrite the ideas that humans and animals have a moral status grounded in the same property that differs in degree, that severely mentally incapacitated humans have a greater moral status than animals with the same internal properties, and that a human’s moral status increases as it develops from the embryonic to foetal to neo-natal stages.

Sunday, September 26, 2021

Better the Two Devils You Know, Than the One You Don’t: Predictability Influences Moral Judgments of Immoral Actors

Walker, A. C.,  et al. 
(2020, March 24).

Abstract

Across six studies (N = 2,646), we demonstrate the role that perceptions of predictability play in judgments of moral character, finding that people demonstrate a moral preference for more predictable immoral actors. Participants judged agents performing an immoral action (e.g., assault) for an unintelligible reason as less predictable and less moral than agents performing the same immoral action, along with an additional immoral action (e.g., theft), for a well-understood immoral reason (Studies 1-4). Additionally, agents performing an immoral action for an unintelligible reason were judged as less predictable and less moral compared to agents performing the same immoral act for an unstated reason (Studies 3-5). This moral preference persisted when participants viewed video footage of each agent’s immoral action (Study 5). Finally, agents performing immoral actions in an unusual way were judged as less predictable and less moral than those performing the same actions in a more common manner (Study 6). The present research demonstrates how immoral actions performed without a clear motive or in an unpredictable way are perceived to be especially indicative of poor moral character. In revealing peoples’ moral preference for predictable immoral actors, we propose that perceptions of predictability play an important, yet overlooked, role in judgments of moral character. Furthermore, we propose that predictability influences judgments of moral character for its ultimate role in reducing social uncertainty and facilitating cooperation with trustworthy individuals and discuss how these findings may be accommodated by person-centered theories of moral judgment and theories of morality-as-cooperation.

From the Discussion

From traditional act-based perspectives (e.g., deontology and utilitarianism; Kant, 1785/1959; Mill, 1861/1998) this moral preference may appear puzzling, as participants judged actors causing more harm and violating more moral rules as more moral. Nevertheless, recent work suggests that people view actions not as the endpoint of moral evaluation, but as a source of information for assessing the moral character of those who perform them(Tannenbaum et al., 2011; Uhlmannet al., 2013). Fromthis person-centered perspective(Pizarro & Tannenbaum, 2011; Uhlmann et al., 2015), a moral preference for more predictable immoral actors can be understood as participants judging the same immoral action (e.g., assault) as more indicative of negative character traits (e.g., a lack of empathy)when performed without an intelligible motive. That is, a person assaulting a stranger seemingly without reason or in an unusual manner (e.g., with a frozen fish) may be viewed as a more inherently unstable, violent, and immoral person compared to an individual performing an identical assault for a well-understood reason (e.g., to escape punishment for a crime in-progress). Such negative character assessments may lead unpredictable immoral actors to be considered a greater risk for causing future harms of uncertain severity to potentially random victims. Consistent with these claims, past work has shown that people judge those performing harmless-but-offensive acts (e.g., masturbating inside a dead chicken), as not only possessing more negative character traits compared to others performing more harmful acts (e.g., theft), but also as likely to engage in more harmful actions in the future(Chakroff et al., 2017; Uhlmann& Zhu, 2014).

Saturday, September 25, 2021

The prefrontal cortex and (uniquely) human cooperation: a comparative perspective

Zoh, Y., Chang, S.W.C. & Crockett, M.J.
Neuropsychopharmacol. (2021). 

Abstract

Humans have an exceptional ability to cooperate relative to many other species. We review the neural mechanisms supporting human cooperation, focusing on the prefrontal cortex. One key feature of human social life is the prevalence of cooperative norms that guide social behavior and prescribe punishment for noncompliance. Taking a comparative approach, we consider shared and unique aspects of cooperative behaviors in humans relative to nonhuman primates, as well as divergences in brain structure that might support uniquely human aspects of cooperation. We highlight a medial prefrontal network common to nonhuman primates and humans supporting a foundational process in cooperative decision-making: valuing outcomes for oneself and others. This medial prefrontal network interacts with lateral prefrontal areas that are thought to represent cooperative norms and modulate value representations to guide behavior appropriate to the local social context. Finally, we propose that more recently evolved anterior regions of prefrontal cortex play a role in arbitrating between cooperative norms across social contexts, and suggest how future research might fruitfully examine the neural basis of norm arbitration.

Conclusion

The prefrontal cortex, in particular its more anterior regions, has expanded dramatically over the course of human evolution. In tandem, the scale and scope of human cooperation has dramatically outpaced its counterparts in nonhuman primate species, manifesting as complex systems of moral codes that guide normative behaviors even in the absence of punishment or repeated interactions. Here, we provided a selective review of the neural basis of human cooperation, taking a comparative approach to identify the brain systems and social behaviors that are thought to be unique to humans. Humans and nonhuman primates alike cooperate on the basis of kinship and reciprocity, but humans are unique in their abilities to represent shared goals and self-regulate to comply with and enforce cooperative norms on a broad scale. We highlight three prefrontal networks that contribute to cooperative behavior in humans: a medial prefrontal network, common to humans and nonhuman primates, that values outcomes for self and others; a lateral prefrontal network that guides cooperative goal pursuit by modulating value representations in the context of local norms; and an anterior prefrontal network that we propose serves uniquely human abilities to reflect on one’s own behavior, commit to shared social contracts, and arbitrate between cooperative norms across diverse social contexts. We suggest future avenues for investigating cooperative norm arbitration and how it is implemented in prefrontal networks.

Friday, September 24, 2021

Hanlon’s Razor

N. Ballantyne and P. H. Ditto
Midwest Studies in Philosophy
August 2021

Abstract

“Never attribute to malice that which is adequately explained by stupidity” – so says Hanlon’s Razor. This principle is designed to curb the human tendency toward explaining other people’s behavior by moralizing it. In this article, we ask whether Hanlon’s Razor is good or bad advice. After offering a nuanced interpretation of the principle, we critically evaluate two strategies purporting to show it is good advice. Our discussion highlights important, unsettled questions about an idea that has the potential to infuse greater humility and civility into discourse and debate.

From the Conclusion

Is Hanlon’s Razor good or bad advice? In this essay, we criticized two proposals in favor of the Razor.  One sees the benefits of the principle in terms of making us more accurate. The other sees benefits in terms of making us more charitable. Our discussion has been preliminary, but we hope careful empirical investigation can illuminate when and why the Razor is beneficial, if it is. For the time being, what else can we say about the Razor?

The Razor attempts to address the problem of detecting facts that explain opponents’ mistakes. Why do our opponents screw up? For hypermoralists, detecting stupidity in the noise of malice can be difficult: we are too eager to attribute bad motives and unsavory character to people who disagree with us. When we try to explain their mistakes, we are subject to two distinct errors:

Misidentifying-stupidity error: attributing an error to malice that is due to stupidity

Misidentifying-malice error: attributing an error to stupidity that is due to malice 

The idea driving the Razor is simple enough. People make misidentifying-stupidity errors too frequently and they should minimize those errors by risking misidentifying-malice errors. The Razor attempts to adjust our criterion for detecting the source of opponents’ mistakes. People should see stupidity more often in their opponents, even if that means they sometimes see stupidity where there is in fact malice. 

Thursday, September 23, 2021

The Execution Hypothesis for the Evolution of a Morality of Fairness

R. Wrangham
Ethics & Politics
XXIII, 2021, 261-282

Abstract

Humans are both the only species known to have a morality of fairness, and the only species in which the social hierarchy is headed by an alliance (a ‘reverse dominance hierarchy’). I present evidence in support of the argument by Boehm (1999, 2012) that these two features are causally linked. The reverse dominance hierarchy is detectable in the fossil record around 300,000 years ago with the
origin of Homo sapiens. From then onwards, according to the execution hypothesis, an alliance of adult males held the power of life and death over all members of the social group, and they used this power to advance their interests. The result was an intense selective pressure against antisocial behaviour and in favour of prosociality, cooperation and conformity to group norms, whether the norms were beneficial for the group as a whole or merely for the male alliance. The execution hypothesis thus argues that group dynamics have operated for at least 12,000 generations to favour the evolution of moral emotions, many of which are designed to protect individuals from the threat of severe punishment or death at the hands of a dominant alliance of males. 

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The Persistent Importance of Moral Enforcement

Ever since Durkheim (1902), hunter-gatherers and others living in small-scale, acephalous bands have been known to live by a set of norms that categorize numerous behaviours as right or wrong.  Morally circumscribed behaviors concern food, sharing, sexuality, marriage partners, emotional expression, disrespect, secret societies and much else, and are the topic of much daily conversation. To judge from one detailed study of Ju/’hoansi Bushmen hunter-gatherers, moral enforcement comes more from punishment than reward, with males being sanctioned more than females (Wiessner, 2005).

Wednesday, September 22, 2021

COVID Medical Coverage is Over: Insurers are restoring deductibles and co-pays, leaving patients with big bills

Christopher Rowland
The Washington Post
Originally posted 18 Sept 21

Here is an excerpt:

But this year, most insurers have reinstated co-pays and deductibles for covid patients, in many cases even before vaccines became widely available. The companies imposed the costs as industry profits remained strong or grew in 2020, with insurers paying out less to cover elective procedures that hospitals suspended during the crisis.

Now the financial burden of covid is falling unevenly on patients across the country, varying widely by health-care plan and geography, according to a survey of the two largest health plans in every state by the nonprofit and nonpartisan Kaiser Family Foundation.

If you’re fortunate enough to live in Vermont or New Mexico, for instance, state mandates require insurance companies to cover 100 percent of treatment. But most Americans with covid are now exposed to the uncertainty, confusion and expense of business-as-usual medical billing and insurance practices — joining those with cancer, diabetes and other serious, costly illnesses.

(Insurers continue to waive costs associated with vaccinations and testing, a pandemic benefit the federal government requires.)

A widow with no children, Azar, 57, is part of the unlucky majority. Her experience is a sign of what to expect if covid, as most scientists fear, becomes endemic: a permanent, regular health threat.

Tuesday, September 21, 2021

White Evangelicals Shun Morality for Power

Charles Blow
The New York Times - Opinion
Originally published 19 Sept 21

Here is an excerpt:

I had hoped that there were more white evangelicals who embraced the same teachings, who would not abide by the message the Grahams of the world were advancing, who would stand on principle.

But I was wrong. A report for the Pew Research Center published last week found that, contrary to an onslaught of press coverage about evangelicals who had left the church, disgusted by its embrace of the president, “There is solid evidence that white Americans who viewed Trump favorably and did not identify as evangelicals in 2016 were much more likely than white Trump skeptics to begin identifying as born-again or evangelical Protestants by 2020.”

That’s right, the lying, philandering, thrice-married Trump, who has been accused by dozens of women of sexual misconduct or assault, may actually have grown the ranks of white evangelicals rather than shrunk them.

To get some perspective on this, I reached out to an expert, Anthea Butler, a professor of religious studies and Africana studies and the chair of the religious studies department at the University of Pennsylvania. She is also the author of the recently released book “White Evangelical Racism.”

As Professor Butler told me, the reason that some people might be surprised by these findings is that “they believed the hype.” For years, evangelicals had claimed that they were upholding morality and fighting injustice. But what the movement has really been since the 1970s, said Butler, is “a political arm of the Republican Party.” As Butler put it, evangelicals now “use moral issues as a wedge to get political power.”

Butler concluded, “We need to quit coddling evangelicals and allowing them to use these moral issues to hide behind, because it’s very clear that that’s not what the issue is. The issue is that they believe in anti-vaxxing, they believe in racism, they believe in anti-immigration, they believe that only Republicans should run the country and they believe in white supremacy.”

Monday, September 20, 2021

Intergroup preference, not dehumanization, explains social biases in emotion attribution

F. Enoch, S. P. Tipper, & H. Over
Cognition
Volume 216, November 2021, 104865

Abstract

Psychological models can only help improve intergroup relations if they accurately characterise the mechanisms underlying social biases. The claim that outgroups suffer dehumanization is near ubiquitous in the social sciences. We challenge the most prominent psychological model of dehumanization - infrahumanization theory - which holds outgroup members are subtly dehumanized by being denied human emotions. We examine the theory across seven intergroup contexts in thirteen pre-registered and highly powered experiments (N = 1690). We find outgroup members are not denied uniquely human emotions relative to ingroup members. Rather, they are ascribed prosocial emotions to a lesser extent but antisocial emotions to a greater extent. Apparent evidence for infrahumanization is better explained by ingroup preference, outgroup derogation and stereotyping. Infrahumanization theory may obscure more than it reveals about intergroup bias.

Highlights

• Infrahumanization theory predicts outgroups are often denied uniquely human emotions.

• However, to date, antisocial uniquely human emotions have not been investigated.

• We test attributions of prosocial and antisocial emotions to social groups.

• Attributions of antisocial human emotions were stronger for outgroups than ingroups.

• We find no support for the predictions of infrahumanization theory.

From the General Discussion

Our results dovetail with recent empirical work that challenges the predictions made by Haslam's (2006) dual model of dehumanization (Enock et al., 2021). This research showed that when undesirable human-specific characteristics (such as ‘corrupt’ and ‘selfish’) are included in overall measures of humanness, there is no evidence for either animalistic or mechanistic dehumanization of outgroups as characterised by the dual model. Rather, desirable human qualities are more strongly attributed to ingroup members and undesirable human qualities to outgroup members. The present work extends these findings by further demonstrating the importance of considering sociality confounds when measuring psychological processes of ‘dehumanization’, this time through another highly prominent framework within the field.

During the review process, it was put to us that because dimensions of valence and sociality correlate highly in our pretest, the two constructs are “indistinguishable”, thus rendering our critique obsolete. We believe this represents a misunderstanding. Height and weight are strongly positively correlated, yet they are distinct constructs. Similarly, even though emotions that are generally perceived as prosocial may also perceived as positive to experience, and emotions that are generally perceived as antisocial may also be perceived as negative to experience, the two constructs are clearly conceptually distinct. While sadness is negative to experience, it is not inherently antisocial in character. Schadenfreude on the other hand is, by definition, positive to experience but antisocial in character.

Sunday, September 19, 2021

How Does Cost-Effectiveness Analysis Inform Health Care Decisions?

David D. Kim & Anirban Basu
AMA J Ethics. 2021;23(8):E639-647. 
doi: 10.1001/amajethics.2021.639.

Abstract

Cost-effectiveness analysis (CEA) provides a formal assessment of trade-offs involving benefits, harms, and costs inherent in alternative options. CEA has been increasingly used to inform public and private organizations’ reimbursement decisions, benefit designs, and price negotiations worldwide. Despite the lack of centralized efforts to promote CEA in the United States, the demand for CEA is growing. This article briefly reviews the history of CEA in the United States, highlights advances in practice guidelines, and discusses CEA’s ethical challenges. It also offers a way forward to inform health care decisions.

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Ethical Considerations

There have been a few criticisms on ethical grounds of CEA’s use for decision making. These include (1) controversies associated with the use of QALYs, (2) distributive justice, and (3) incomplete valuation. We discuss each of them in detail here. However, it is worth pointing out that cost-effectiveness evidence is only one of many factors considered in resource allocation decisions. We have found that none of the international HTA bodies bases its decisions solely on cost-effectiveness evidence. Therefore, much of CEA’s criticisms, fair or not, can be addressed through deliberative processes.

QALYs. The lower health utility, or health-related quality of life, assigned to patients with worse health (because of more severe disease, disability, age, and so on) raises distributional issues in using QALYs for resource allocation decisions. For example, because patients with disabilities have a lower overall health utility weight, any extension of their lives by reducing the health burden from one disease “would not generate as many QALYs as a similar extension of life for otherwise healthy people.” This distributional limitation arises because of the multiplicative nature of QALYs, which are a product of life-years and health utility weight. Consequently, the National Council on Disability has strongly denounced the use of QALYs.

Alternatives to QALYs have been proposed. The Institute for Clinical and Economic Review has started using the equal value of life-years gained metric, a modified version of the equal value of life (EVL) metric, to supplement QALYs. In EVL calculations, any life-year gained is valued at a weight of 1 QALY, irrespective of individuals’ health status during the extra year. EVL, however, “has had limited traction among academics and decision-making bodies” because it undervalues interventions that extend life-years by the same amount as other interventions but that substantially improve quality of life. More recently, a health-years-in-total metric was proposed to overcome the limitations of both QALYs and EVL, but more work is needed to fully understand its theoretical foundations.